NPIMap

Organization Active NPI

East Georgia Healthcare Center Inc

  • Migrant Health Clinic/Center
  • Baxley, GA
National Provider Identifier
1801239389
Registry record updated Aug 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Migrant Health Clinic/CenterTaxonomy code 261QM1000X
Legal business name
EAST GEORGIA HEALTHCARE CENTER INC
Practice address
1636 Hatch Parkway South
Baxley, GA 31513
Phone
(912) 705-5656
Fax
(912) 705-5652
NPI assigned
Apr 15, 2013
Last updated
Aug 7, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jill R Sorrells
Title
Cfo
Phone
(478) 237-6262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Migrant Health Clinic/Center 261QM1000X Primary

Addresses

Primary practice location

1636 Hatch Parkway South
Baxley, GA 31513

Mailing address

215 N Coleman St
Swainsboro, GA 30401-3530
Phone (478) 237-6262

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050722000569 GA Part B Supplier - Clinic/Group Practice 0547228686 Receives reassigned benefits from 49 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wadley, GA; Vidalia, GA; Sylvania, GA; Swainsboro, GA; Mount Vernon, GA; Stillmore, GA; Statesboro, GA; Soperton, GA…
O20140402001089 GA Part A Provider - Federally Qualified Health Center (FQHC) 0547228686 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baxley, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801239389. Details of each certification follow.

Federally qualified health center certification: CCN 111977

Legal name
EAST GEORGIA HEALTHCARE CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 2, 2014
Last certification
Apr 2, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 29, 1992 in GA
Enrollment address
1636 Hatch Parkway South
Baxley, GA 31513-4376

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory
Tax ID family
East Ga Hlthcare Inc21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

1636 Hatch Pkwy S
Baxley, GA 31513
Phone (912) 705-5656

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joel Salgado Individual Corporate Officer Jan 1, 2021 10%
East Georgia Healthcare Center, Inc. Organization, Swainsboro, GA Non-profit Operational/Managerial Control Jan 1, 2014 100%
Gwendolyn Love Individual Corporate DirectorBoard Member Apr 22, 2013 6%
Lynda Morgan Individual Corporate DirectorChairman Apr 22, 2013 6%
Theron D Faison Individual Corporate DirectorBoard Member Apr 22, 2013 5%
Jennie W Denmark Individual W-2 Managing EmployeeCeo Apr 22, 2013 6%
Elizabeth Hendrix Individual Corporate DirectorBoard Member Apr 22, 2013 6%
Cleveland White Individual Corporate DirectorBoard Member Apr 22, 2013 5%
Martin R Sheldon Individual W-2 Managing Employee Aug 1, 2021
Ken Mercer Individual Corporate DirectorBoard Member Apr 22, 2013 6%
Luis Machado Individual Corporate DirectorBoard Member Apr 22, 2013 5%
Amanda R Brown Individual Corporate DirectorBoard Member Apr 22, 2013 5%
Jill R Sorrells Individual W-2 Managing EmployeeCfo Apr 22, 2013 6%

Owners & managing parties with NPI records 18

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438905600000",
    "number": "1801239389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N COLEMAN ST",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013530",
            "telephone_number": "478-237-6262",
            "fax_number": "478-237-9138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1636 HATCH PARKWAY SOUTH",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "31513",
            "telephone_number": "912-705-5656",
            "fax_number": "912-705-5652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GEORGIA HEALTHCARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-15",
        "last_updated": "2015-08-07",
        "status": "A",
        "authorized_official_last_name": "SORRELLS",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "478-237-6262"
    },
    "taxonomies": [
        {
            "code": "261QM1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Migrant Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baxley, GA

Sources for this page

Verify at the official NPI Registry.